Parents are important partners in working with health care providers to maintain their child’s health. As with all other relationships, communication is the most important part of any interaction, including health care relationships. This is certainly true during a dental appointment. What role do we, as pediatric dentists, expect parents to play during their child’s dental visit? Parents are sometimes surprised and ask why they may not be invited to accompany their children into the operatory for dental visits.

There are a few different answers for this, and the responses vary for different practitioners, their philosophies, and the type of patient population they treat. We will comment on some of the factors taken into consideration. Children are all unique and special in their own way, and as pediatric dentists, we recognize that children cannot all be treated the same. There are, however, common personality types that children will display that will help the dental team determine how to proceed with a dental appointment so that child, parent and dental team are all happy with the outcome.

There are many theories related to child development and temperament, but one commonly accepted theory describes a childʼs temperament as being categorized loosely as easy, difficult, and slow to warm.

Easy children are described as being adaptable to new situations, generally displaying positive moods and emotions, and having normal sleeping and eating patterns. Difficult or strong willed children are described as being more irritable and emotional, as well as fussy with regards to eating and sleeping. Slow to warm children tend to have a lower activity level, and are cautious in or withdraw from new situations or people. They also are slow to adapt to new situations but will often be accepting after repeated exposure.

Approximately 65% of children will exhibit many of the traits common to one of these categories, with the rest exhibiting traits common to two or more of the categories. Parents can be very helpful to the dental team by answering questions about how their child responds to new situations, new people or strangers and new experiences. From the time the child arrives in the dental office,the dental team will make multi-modal attempts to establish communication with your child. Even things as simple as eye contact, shaking hands, giving 5, or saying hello are all examples of communication attempts through different modes-visual, aural and touch.

Allowing children to look around and explore their environment is important, as well as allowing them to ask questions (as age allows) so dental assistants, hygienists and dentists can establish a relationship and rapport. Some children will readily interact with staff (easy), whereas others may take a while to warm up, or simply refuse to interact. Parents often make the mistake of answering for their child. While we appreciate the input, we really want to learn how the child will interact with new people and a new environment. That information helps us to help you and your child have a positive dental experience.

The initial consultation appointment allows the dental team to not only establish treatment needs, but just as important, determine how to manage behaviour.In the event the dentist decides that, from an age and developmental standpoint, treatment can be completed conventionally in the office, a decision is made regarding whether it is best that a parent be present in the treatment room or absent during the treatment appointment.

Factors influencing this decision include assessment of the childʼs temperament, interaction of the child with the parent and the childʼs response to the members of the dental team. If, for example, a child will willingly cooperate and follow instructions, having established effective communication with the dentist and assistant, then parental presence will likely not affect the outcome of the appointment.We like the analogy of a child going to school. While there may be resistance initially from the child about leaving mom or dad outside the school, mom or dad will not be allowed to remain in the childʼs classroom during school. If,however, in an attempt to establish effective communication with the child either
1) the parent speaks for the child or interacts with the team on behalf of the child or
2) the child preferentially defers to the parent bypassing communication with the dental team, then the behavioural interaction and any treatment planned is more likely to fail.

By removing a parent from the treatment room, the school-aged child will most often revert to a more independent state, as they would in a social environment such as school, andview the dentist/assistant as being individuals of authority and accept guidance. The situation is not quite so clear for preschool children and this is where child temperament is even more important. Easy children will likely do well whether or not mom or dad are present. Slow to warm children initially may not do well but, if parents and the dental team take time to establish a connection the child will eventually warm and do well. Difficult or strong willed children are the real challenge. Frequently, difficult behaviour is misinterpreted. In many cases, this behaviour is often an attempt to manipulate their environment and the people with whom they are interacting. Strong willed children require clear expectations and clear boundaries. Parents can assist the dental team by supporting directions given by the dental team members. Consequences which are logical and reasonable can be very effective in securing and maintaining a childʼs cooperation. A consequence of failing to follow an instruction like “Hop into my dental chair” may be met with the consequence of mom or the dental team placing the child in the chair or of child being separated from mom. The error many parents make with difficult children is allowing the child to set the agenda. In other words, some parents of strong willed children will allow the child to determine how the appointment will proceed rather than recognizing that we, as the adults, have the experience, knowledge, wisdom and responsibility to make that determination.

The bottom line is that you and your dentist must agree on how your childʼs behaviour is guided and shaped during dental appointments. If your dentist asks that your child be treated while you wait in the waiting room, it is because he or she has determined that in their professional opinion your child would respond best to one-on-one communication, to increase the likelihood having a successful appointment. Communication is the key to success.